Medical insurance in India for the elderly – II

(This is a follow up to my earlier post dated 31-3-2013 dealing with a government sponsored insurance scheme for the central government employees and pensioners)

In India medical insurance policies are currently being offered to public by several Public Sector Undertaking (PSU) insurance companies like National, New India, United India or Oriental, etc or by a host of private companies like Bajaj Allianz, Max Bupa, Religare, etc). Collectively these can be grouped as MEDICLAIM type insurance wherein an insured customer is covered mainly for claims arising out of the expenditure incurred by him/her as an in-patient in a ‘network’ of private and government hospitals recognized by the insurance company. Most of these companies either have policies specifically configured for the senior citizens or are extended to age-bands that include the elderly. This is a welcome development.

The customer may choose either a post-hospitalization reimbursement of the expenditure claimed or, more assiduously marketed by the insurance companies, a system of ‘cashless’ direct payment of the incurred expenses by the insurer to the hospital. Many companies, especially those in the public sector, actually outsource the claims management (initiation/intimation, authorization and final settlement) to an interface organization, euphemistically called ‘Third Party Administrator (TPA)’ that is supposed to have the requisite technical and medical expertise to settle the claims. Others declare that they have efficient in-house teams to take care of the claims.

In terms of the sum insured amounts, range of coverage and the corresponding premium, clearly, the policies offered by the public sector companies are much cheaper than the ‘products’ (yes, the policies are offered or being sold as insurance products !) brought to the market by the private players. But premium should probably not be the only criterion to select a health insurance policy. In any case these types of policies target and cover middle and preferably higher income group people usually not eligible or not opting for insurance cover offered by the central and some state governments. Together the total coverage may not be more than about a few percent of the population of the country. 

Be that as it may, here is a checklist for anybody looking for a useful medical insurance in India today to carefully consider (looking beyond the advertisement blurbs, glossy brochures and persuasive agents) before making a proposal to an insurance company. One may not have much of a choice as regards many of the terms and conditions governing a policy. But at least one should be fully aware of them and make a more informed choice among the various policies available in the market.

The issues are important for everybody. For the elderly, the general importance stems from the usually limited funds available to them. But there are many issues specially relevant to them, like the limit of indemnity, maximum age of entry, premium loading and the co-pay requirement with progressing age, the waiting period for the pre-existing illness that are more typical of the old age and the permanent exclusion for what the companies (i.e. their panel of doctors) judge as the congenital disorders.

Moreover, it should be emphasized that these policies do not, usually, cover expenditure for visits either to hospital OPD or to dispensaries of neighborhood general practitioners or consulting offices of specialist doctors for regular treatment of chronic diseases like diabetes or hypertension or osteoporosis, etc, some or all of which could be of major concern to the senior citizens. 

• Sub-limit/ceiling of expenditure (as a % of the sum insured, SI, or the limit of indemnity per illness, defined as a specified period of continuous treatment as an in-patient in a hospital) under any head – accommodation, ICU stay, medicine/drugs, nursing, pathological/laboratory tests, radiological tests (X-ray, etc), scans, CAT lab diagnostic procedures, surgical procedure, operation theatre, anaesthesia, surgical materials/gases used for anaesthesia/drugs used in OT, any procedure to put a prosthetic on or inside the body as a part of the treatment, etc.
• Limit of expenditure on or exclusion of any drug (generic or branded), vitamins, supplements, etc.
• Limit of expenditure on or exclusion of any prosthetic (type, material) put on or inside the body as a part of the treatment.
• List or schedule of day care (less than 24 hrs) procedures (such as dialysis, chemotherapy, radiotherapy, etc) covered. Can these be taken in the OPD of a recognized hospital or only as an in-patient ?
• Co-pay (% of the actual expenditure OR % of the admissible claim) due to any reason – treatment in a non-network hospital, claims arising in cases of pre-existing illness.
• Of especial importance for the senior citizens, (a) is there an entry age limit (70 or 75 or 80 years ?) for joining a plan beyond which insurance coverage will be refused; (b) will the premium be progressively enhanced with aging of the insured (sometimes there are pre-defined premium loading on renewal after a specified age limit is crossed, say, 65 years) or will the % co-payment increase ?
• One should find out the overall/ultimate limit of indemnity (usually a small multiple of the SI) even for a policy that is continuously renewed and no further coverage beyond that limit would be provided for the particular insured [It should be noted that this milepost of denial of cover by one insurance company may eventually be (like a credit rating a credit card user develops with one card company) freely shared by others in deciding to provide or deny the cover in future. This also means that the promised automatic lifetime renewal may be just that – a promise.]
• Senior citizens joining a policy should be especially aware that most companies disallow coverage for some very common disorders (like kidney or gall stones, hernia, piles, benign prostatic hypertrophy, any condition requiring hysterectomy, etc) for at least 12 months after joining, some 24 months (called specific waiting periods)
• What is a pre-existing illness ? Complete list of pre-existing illnesses and the mandatory waiting period before each of these are covered (say, a continuous claim-free period of 24 to 48 months) should be scrutinized before joining the plan. It may mean, for instance, that a diabetic entering the plan at the age 61, with an waiting period of 48 months, will have to keep paying the premium for up to 4 years but can not make any claim against any hospitalization related to any and every disease or health issues (say, peripheral vascular disease) that can be shown to arise due to diabetes. By the time one becomes eligible for cover, higher co-pay might kick in due to one’s reaching an age band of 65 years and above ! Some plans may cover pre-existing illness after a lower waiting period (say, 12 months) but with a co-pay requirement of say, 20% or coverage limited to 50% of the sum insured.
• Can an independently happening diseased condition be deduced or connected to a pre-existing condition (e.g. a cardiac problem happening to a diabetic patient – if such an eventuality occurs within the waiting period will the claim be denied ?). It may be advisable to clarify such issues with the panel of doctors of the insurer before buying the policy. 
• If a pre-existing illness is covered after a waiting period, it should be clarified whether the coverage is for any and every disease or illness that may be associated with the defined pre-existing disease ?
• Congenital disorder/illness and any related treatment are usually permanently excluded. It should be clarified if a correctional treatment or one arising out of such a disorder be considered as a pre-existing illness after a specified waiting period or excluded ?
• What happens when the insured gets hospitalized for some emergency medical condition and on final diagnosis this turns out (based on the medical diagnosis) as a result of a pre-existing or congenital disorder genuinely unknown to the insured? Will his claim be denied outright ?
• While most companies allow a small percentage of SI as expenditure for both pre- and post-hospitalization treatment, further tests etc, if these treatments and tests are not taken at the OPD of the same hospital (in which case the TPA or insurance department of the hospital may help) the claim form sections/documentation required to be filled by the attending doctor or his private clinic may pose practical difficulties (without satisfactory filling of the forms the claim may be denied or settlement delayed).
• In many emergency room (ER)/casualty ward scenarios (before formal admission to the hospital) the patient’s relatives are often not provided with the complete and official prescriptions for medicines to be urgently procured for administering to the patient or the detailed heads (like a blood test/ECG/MRI or ER bed charges, consumables, etc.) not specified under which bills are raised and expected by the hospital to be paid immediately (cash/CC). In absence of a proper prescription consistent with the bills and the amounts paid, claims for reimbursement may be denied or settlement delayed. The relatives either may not be knowledgeable enough or in a stable metal state to insist on such details. Check with the company and the hospital, whether the expenditure incurred in the ER is covered as pre-hospitalization expense or as an integral part of the hospitalization claim.
• Is the ambulance charges part of the hospitalization or the pre-hospitalization claims (is there any medical authorization required ?)
• Is there a provision of annual health check up within the scheme and how is it paid for ? Is it subjected to continuous renewal of the policy for a specified number of claim-free years ?
• Is there a renewal bonus and if so how does the benefit accrue to the insured ?
• Finally, one should be aware of the reality of the cashless claim settlement in a hospital scenario vis-à-vis reimbursement of claim made post-discharge (documentation required in the latter case should be clearly understood and diligently procured to avoid harassment).

Despite assurances by the insurance company officials, their agents and the customer care staff of the third party administrator (TPA) agencies actually administering the medical claims, the so-called cash-less procedure is anything but painless. Prior to (or on the day of hospitalization) the insured patient has to get an authorization from the TPA for the hospital treatment, which requires filling up a prescribed pre-authorization form. Help of the hospital (one would be lucky if the hospital has a dedicated TPA department) is required to fill this form and send it to the TPA for their approval.

Usually it is expected that the insured waits (may be for 3-4 hours or more), may be at the hospital reception or some other convenient place till this approval comes and is admitted only after the financial commitment by the insurer is available to the hospital formally. In case the insured gets admitted pending the approval (which may be needed in emergency cases or where the insured requires to undergo urgent diagnostic tests, procedures as per medical advice) he/she may have to either opt for the reimbursement of the claims post hospitalization or give an undertaking to pay the difference in the hospitalization charges between the actual and the amount to be approved by the TPA in due course.

Post-discharge all the medical and billing information will have to be sent to the TPA (usually  this is done by the hospital) for their perusal, evaluation against the insurer profile with them (most notably about the exclusions due to pre-existing and congenital diseases, if any) and according to their norms regarding what charges mentioned within the hospital bills  (especially some overheads like documentation and office work or some consumables and excluded items included in the bills) are or are not be payable. This processing may take, together with the hospital bill and document preparation, upwards of six hours, as per common experience). Only after the final approved settlement from the TPA, as the authorized representative of the insurance company, is received by the hospital, the insured patient may get his/her discharge, if necessary, by paying any shortfall in payment as required by the hospital.  

Atrophy of ethical common sense - Your wrong doing versus mine

Everybody knows that two wrongs do not make it right. In other words the wrong things, say, of similar nature done by somebody else in the past cannot justify wrongs inflicted by you or me at the present time. This is an ethical common sense hard to escape for anybody. Yet in most conversations between the political adversaries in India this value is conveniently given the go by. At times it does look like a fight between children or silly ego clashes between temperamental adults. But we are talking about serious matters often involving death, destruction and destitution of a large number of poor and helpless people who are anyway living at the edge and mark their time at the mercy of the nature and some powerful men.

Whenever one side criticizes the other of some wrongdoing as of today, rest assured that swift riposte from the other side mentioning similar or related misdeeds of the critic would be invited. If my party is accused of post-Godhra state-sponsored Gujarat pogrom killing two thousand Muslims in 2002, be sure that I will put you on the mat about your party’s active role in organizing and conducting butchering and burning of three thousand Sikhs in 1984 and the government machinery, most notably the police, being complicit in allowing the carnage to happen and sabotaging the dispensation of justice over the next 30 years. If you are going to discuss Gulberg or Naroda Patiya massacre and be silent on the burning of the Sabarmati Express near Godhra that will be an one-sided talk and an indication of your lack of fairness and balanced outlook. If there are a flurry of corruption scandals, during our regime, and losses of public money due to the acts of omission and commission of some of our ministers and bureaucrats working under them, how can we let anybody (including our interlocutors) forget similar misappropriation of funds and cases of financial misdemeanor and sweetheart deals, tailor made policies to suit your crony industrialists and businessmen under your watch in different parts of the country. And so does unspool the blame game.

The amazing thing is that each party feels vindicated by the wrong doing of the other. And once the other party could be maligned with sufficiently strong coat of accusations one could feel relieved and live with one’s own share of the charge sheet. One also has to admire the elephantine memory on both sides of the political divide, helped as they are by technology and perhaps some professional support. Except that such skills are not used to accumulate statistics of hunger, malnutrition and stunted growth with equal perspicacity when the affected population live and die under our political dispensation. All our analytical acuity and statistical prowess would rather be used to prune the number of people taking their lives in our villages from the category of ‘real farmers’ having proper land deeds in their names (and not in the name of their old and infirm fathers), and not just anybody and everybody connected to agricultural activities because they have no other employment, the target being ‘zero farmer suicide’ as reported by some states.

Certain amount of self-righteousness is perhaps at the heart of any political action. But aren’t we overdoing it on all sides ? Moreover, being right should also entail not being wrong on all or most counts that we accuse our opponents about. Sadly, that happens rarely, if at all. As a result no one can occupy the moral high ground any more. If the energy expended and ingenuity marshalled in fault finding exercise directed to others, for a change, would have been redirected towards ourselves and our own decisions and actions, that in turn would have motivated us to take the corrective actions, hopefully, the initiation of the chain of blame would have been much more muted or even stalled from growing by inviting and adding to a similar chain of reverse polarity.  

Pursuing authoritarian rule through democracy : Narendra Modi

Despite the elitist skepticism about the electoral politics in India and many infirmities in the practice of democracy in our country, few will dispute the fact that both Narendra Modi and Mamata Banerjee had roared to win their respective state assembly elections with massive democratic mandate. Modi for the third successive reign, Mamata for the first time after demolishing the red citadel of 34 years standing. The pathways to power were very different. As persons they have many differences in characteristics, so also may be in their officially projected worldviews including political ideologies and affiliations. But there appears to be a singular unanimity in certain basic features of temperament and style of functioning when one observes these two currently prominent politicians in India. In this first part we deal with the peregrinations of Modi. We hope to devote a future post to Mamata.

-         Modi’s initial gambit was to project a hardline Hindutva face to encash the majoritarian anxiety and anger sweeping Gujarat like many other parts in the country following the communal riots post Babri Masjid demolition in Mumbai and elsewhere and then the Mumbai blast 1993 and thereby create a strong base in Gujarat. The Hindutva dividend accrued to him through a clear-cut democratic process, namely, the assembly election in 2002 that took place with the backdrop of the Gujarat carnage.

-         In the next stage, the challenge of wide spread national and international condemnation and criticism that the state government and administration faced with regard to its acquiescent role during the pogrom and willfully partisan rehabilitation policy it followed in the aftermath, was cleverly turned into an opportunity for consolidating his vote bank among the majority community in Gujarat in the name of defending the ‘asmita (pride)’ of the five crore Gujaratis and promoting the cause of Hindutva under attack from the ‘pseudo-secularists. In course of time by a subtle spin Hinduvta was made synonymous with nationalism. Fighting Islamic terrorists, axiomatically assumed to be Pakistan-supported, by any means, extra-judicial or otherwise, was a duty a truly nationalist chief minister and his administration was justifiably proud of executing. The 2007 assembly election results handing him an absolute majority mandate gave him confidence in continuing more vigorously his ongoing experiment with a model for an economic development of Gujarat he had already embarked on and that he would later claim as a panacea for the whole country.

-        The third stage was the economic transformation of Gujarat along the clear-cut capitalist prescriptions. The liberal economic policy pursued by the government coupled with the traditional entrepreneurial zeal and the business skill of the Gujaratis helped the state notch up a very good macroeconomic growth rate (among the highest achieved by various states in India). The stick-at-nothing approach to achieve this goal made Gujarat the most business friendly state in the country, acquiring land for infrastructure (roads and connectivity) and other ‘public purpose’ that included private industry and other entrepreneurial activities, encouraging cash crops, allowing preferential share in scarce water resources to agri-business and industry. There was no ambivalence as to who and what the government stands for and no pretension for equity or inclusiveness. Income disparity, children malnutrition, water scarcity and agricultural distress in many drought affected districts, increasing segregation of the urban population along the religious lines, poor and dwindling rehabilitation of the 2002 riot victims and to top it all increasing debt that the government incurred in order to live up to its promise of business friendliness – all of these and more were brushed aside in the name of achieving the enviable growth statistics. An impression has been created among the upper and middle classes, not only within Gujarat but in many urban centers of India that an economic miracle has been engineered in Gujarat. 

-         Through these ten odd years of rule Modi had managed to decimate opposition Congress party electorally through huge democratic mandates which was rationalized as a popular response and support of the state electorate to first his Hindutva ideology and later his image as a leader of an efficient business-enabling state administration taking the state to great and demonstrable prosperity. That he had always had his detractors within his party, BJP, and wider organizations of the Sangh Parivar was always known. There were both muted and open criticism within the party and the Sangh about some of his policies, biases and most importantly his autocrat like brook-no-opposition style of functioning. But the spectacular way he had managed to sideline senior state party leaders like Waghela, Keshubhai Patel and others and alienated an important Sangh apparatchik like Sanjay Joshi and eventually pushed them out of the party and even hounded some of them out of the state politics confirm his Machiavellian prowess and the determination to remove any obstacle to the path of his preeminence in the party. Interestingly, he has even reconfigured his relationship with the Sangh Parivar, maintaining a studied distance from some of its important organizations like VHP, the ones that gave him his initial break.

-         Modi’s brand of democratic functioning is most illuminatingly demonstrated recently in the new Lokayukta bill he is said to be piloting in the state assembly which he hopes to turn into law by dint of his ‘democratic’ majority. He is clearly trying to sabotage the currently nominated Lokayukta (his dogged opposition to the decisions of the Governor, legal challenges at the High Court having failed to yield desired result, i.e. a Lokayukta of his choice) by bringing in a new law where a new selection procedure is being suggested that will clearly be subservient to and controlled by the chief minister.

-        Post his third time anointment as the chief minister after winning absolute majority in the 2012 assembly elections his script is showing up a trajectory of him coming up with increasing frequency to Delhi and many other places (recently Haridwar). These involve occasions of not merely attending important BJP party meetings and functions of national significance but special seminars, meets, discussions for projecting himself, quite successfully, towards the party rank and file, to media and the public at large as the one and the only alternative for BJP’s the prime ministership candidate. If the topmost leaders of BJP are already feeling the heavy breathing of an ambitious and ruthless leader like Modi on their shoulder they are not showing it and making brave noises about democratic functioning of the party. But the first capitulation has already happened in that Modi has bulldozed his way into the top decision making body of the party, namely, the parliamentary board which, at the appropriate time, is expected to ‘democratically’ nominate one among the many equals as the potential prime minister of the shadow cabinet.

Thus in many ways Modi’s is a saga of using his apparent democratic advantage to allow him to pursue a type of authoritarian rule that has many historical parallels with classic developments of fascism in Europe during the last century. One waits with bated breath if the country's democratic system could be subverted yet again to construct the second attempt at installing a quasi-authoritarian dispensation at the center.

Medical insurance in India for the elderly - I

Health Scheme for the Central Government pensioners

(This is the first part of a multi-part post on this subject. This is not meant to be a comprehensive source of information on various insurance schemes for the aged in India as of now, but rather tries to offer somewhat of a critical appraisal from a user perspective cutting through the received wisdom and advertisement blurbs. The present one talks about one of the most important government funded schemes, a subsequent post will take a look at some of the other health insurance policies available in the market.)

A major escalation in the drug prices and the cost of an increasingly privatized health care in India that has occurred over the last two decades and the liberalized economic policies pursued by the government are significantly correlated, notwithstanding the expected murmurs of protests from the liberalization fetishists against this inference. There seems to be enough wisdom within the government (PMO/panning commission) and advice from outside propelling the government propelling it to get out of the welfare commitment to supply public health care as much as possible and allow private health care providers to take its place and let the market enjoy a free run. This is more than clear both by the various policy pronouncements and through experiences on the ground. Ample statistics exist in the public domain to demonstrate the ballooning of what has been rather graphically described as the OUT-OF-POCKET (OOP) expenditure for health (generally accepted to be about 70% of the total) for the majority of Indians. This is a significant and potentially disastrous burden especially for the poor and of course the elderly and may lead to penury and destitution. I have had occasions to discuss these issues in some of the earlier posts in seinjuti (see, “Drug prices escalation potential in India”, November 5, 2011, “OOP health expenses of India”, November 6, 2011) and more recently elsewhere (“Price of health”, silvertalkies, October 6, 2012).

In this connection, one has only to look at the dwindling utility and effectiveness of the Central Government Health Scheme (CGHS). This is one among the few relatively well-organized government sponsored schemes through which a modicum of medical insurance benefit is provided to the employees (and their dependents, total beneficiaries estimated to be about 4 million or so) working in various central government departments and offices all over the country and autonomous institutions like CSIR under the government of India. CGHS scheme and the rules governing it [under the broader Central Services (Medical Attendance) or the CS (MA) Act of 1954] cover both serving government employees and the pensioners. For the latter, since we are concerned here about the elderly, this service is usually available after retirement either by paying a sort of annual premium or (what is becoming the norm more recently) by making a one-time lump sum payment. In this sense this is like a usual medical insurance offered by private companies for the elderly.

Over the last several years, because of the deliberate reduction (as a government policy) in the CGHS approved rates for a large number of diagnostic tests and procedures (both taken as in-patients or in the OPD) and generally not accepting the market rates charged by good private hospitals, many of these are opting out of the CGHS scheme or are being de-recognized by the government. Even where the treatment in some of these hospitals are not completely disallowed, the CGHS insured has to agree to pay the difference between the rates charged by the hospital and those allowed under the CGHS schedule, even before the admission or undergoing a procedure. Hospital bills may also create such differentials due to the price differences between branded drugs sometimes prescribed by the hospitals and the equivalent generics allowed within the CGHS schedule. The same is true about some critical prosthetics (certain high end drug eluting coronary stents used in angioplasty are ruled out under the revised CGHS schedule). More often than not this may mean 40-80% in OOP. Alternatively the insured has to go and get treated at the restricted number of CGHS recognized hospitals where the test and the treatment facilities may not be up to the mark or one does not get to choose his/her preferred or recommended doctors (who are not necessarily associated with or may not choose to operate in these latter hospitals).

The service is operated either as a cash-less (or the direct payment) facility or as a reimbursable one. In the former the pensioner produces document authorizing the hospitalization and the treatment (office memo, letter from an authorized medical attendant, etc) acceptable to the hospital whereupon the treatment is provided without charging the CGHS beneficiary (except for the differential payments explained above that can be substantial in some cases and some hospitals). At the end of the treatment, the hospital sends bills, details of treatment and other documents to the concerned government office/authority for verifying and accepting the expenditure and finally sanctioning the payment as per its accounts office calculations. In case the office disagrees with some parts of the bill in the sense that these are not admissible under the current CGHS schedule these amounts are recovered from the pensioner.

Many elderly pensioners, especially those not having much human support system (relatives and friends) often find obtaining the correct authorization document from the CGHS dispensaries or the city headquarter time consuming and not devoid of harassment, especially as these offices are not always close to their residence or near the hospitals of interest.  

In the case of the reimbursable route, the pensioner makes the payment upfront to the hospital and submits the bills (including complete break up of all expenditure) and the supporting documents like test reports, prescriptions for medicines and tests   appending the same to the application to his/her accounts office. The latter after scrutiny and verification with the hospital, reimburse the expenditure, which could be much lower than the actual depending on the admissible rates of treatment, recognition level of the hospital where the treatments are taken. It may strain one’s credulity, but it is true that if a pensioner, because of his/her salary level at the time of retirement has the medical card branded, for instance, as “semi-private”, he or she would not just be entitled to a hospital accommodation in the semi-private ward or some other below that grade, entitlements for many of the critical treatment costs (including surgical or other procedure charges) are also graded in terms of admissible charges under the CGHS schedule. If one uses a higher than entitled accommodation for some unavoidable reasons or that the hospital does not allow for such gradations of charges and insist on levying standard charges the differences are not reimbursed and the pensioner has to make this payment. Thus it is not difficult to appreciate that despite availing of a government sponsored medical insurance the pensioner may end up incurring substantial OOP expenses.

Anecdotal evidence (based on the actual experiences of many pensioners) indicates that the claim settlement in the case of reimbursement often gets delayed by the cavalier attitude of the hospitals in providing incomplete documentation along with the final bills and completely rigid and often indifferent and non-cooperative handling of such deficiencies in the reimbursement applications by the government accounts offices. Though the pensioner is not really to blame, he/she must personally at his/her own cost get the required documents from the hospital billing department in order to expedite the reimbursement process.

The bright side of the CGHS scheme for the pensioners is that the OPD treatments and tests taken at and medicines prescribed by the designated CGHS dispensaries are practically free of cost (covered within the terms of the scheme). Similar tests and/or treatments can be availed at the recognized hospitals or by doctors from a CGHS empanelled list of the so-called “authorized medical attendant”s or the AMAs  generally at subsidized prices. Unfortunately, however, such dispensaries and AMAs are comparatively few in number and concentrated more in the main cities (about 25 or so) considering the countrywide validity of the scheme.

The number of recognized (empanelled) hospitals is coming down by the year. Many of these being government hospitals, which have to cater to the disproportionately large number of patients especially the poor and those from the lower strata of the population, are ill equipped, lack sufficient facilities, cleanliness and hygiene, important medicines, blood products and sometimes even good doctors. Many pensioners wishing to avail the scheme perforce have to choose to go to these hospitals.

Why secularism and freedom of expression have India specific connotation

The democratic experience in India is, comparatively speaking, shallow. We have been introduced to democracy rather late, around the middle of the last century, our political structure based on a borrowed template and formally modeled more or less on the British practice. India was not a democratic country before the colonial take over by the British or even during the major part of their rule, if one leaves out the last twenty odd years. During this latter period some rudimentary democratic institutions came into being as ad hoc response from the rulers to meet the increasing self-rule demand from the articulate educated Indians belonging to some strands of the nationalist movement. These were by no means expressions of mass democracy.

Anti-British movement led by Gandhi and others in Indian National Congress was primarily a political agitation by the Indian masses geared principally to remove the colonial yoke and aimed at major changes in the political superstructure characterizing the country (or the major parts of the country). To the participants of the freedom movement and the people at large the facile assumption was proffered by the leaders that the ‘freedom’ from the colonial rule will necessarily mean democracy, especially as it was being sought to be safeguarded by a meticulously worked document like the ‘Constitution’ (some very erudite, brilliant and humane Indians of the time having authored it). And with the first countrywide general election based on universal suffrage a significant measure of democratic practice was also demonstrated on the ground.

Despite many apparent failures and limitations of and attempts at subversion on our democracy it has to be ungrudgingly accepted, however, that this aspect of our democratic freedom – the ability of the Indians across the length and the breadth of the country to more or less freely exercise their electoral choices at periodic intervals – has remained sacrosanct for all these sixty five years. Being able to throw out of office through a largely non-violent election process the particularly hated dispensation of Emergency introduced by the Congress party during mid-1970s, or the unusually long (for about 34 years) self-perpetuating mis-governance by the left front in West Bengal that almost appeared as a fait accompli bear testimony to the strength of the functioning though flawed democracy in India. In view of what had happened in terms of the shrinkage of the democratic space in many countries in India’s neighborhood and elsewhere, countries that won freedom from the colonial rule around the same time as India this is rightly considered by many as a significant achievement.

Within this basic and broad democratic framework our polity through its varied and evolving strands (roughly represented by various political parties and groups) has managed to develop its programmes projected to benefit the majority of the people and organize corresponding actions so as to best serve the cause laid down by these programmes. The latter could be addressing planning and executing economic development projects, scientific management of the natural resources, managing country’s finances, creating and organizing infrastructure for health and education for the burgeoning population, engineering social upliftment and promoting social mobility, maintaining peace and harmony among a large and widely heterogeneous population characterized by diverse ethnicity, religion, caste, language, economic conditions, etc.

It is in this context that quite early in our experiment with democracy in the post-independence India (in about twenty years or so), the Congress party which by virtue of the momentum it carried from leading the freedom movement had taken over the governance of almost whole of India, lost the absolute monopoly in deciding the form, the content and the priorities of these programmes and who the beneficiaries of these would be. Partly because of conceptual inadequacy in understanding and mediating democratic reforms in a poor, underdeveloped, predominantly agricultural country with effectively feudal land relations and partly out of plain incompetence, arrogance of power, greed and corruption, the ruling party quickly lost the moral hegemony to lord over such a vast and diverse land. Soon there were other claimants to the mantle. First they came flaunting contrasting ideological worldviews. But gradually the challengers put up the flagstaff of diverse identities – of castes, religions, regional and tribal aspirations for ‘self-determination’ - appearing to shoot their arms and articulate newfound voices through the imposed veil of suzerainty of a central government with an overarching national ethos and perspective.

Since then it has become an open season for competition for occupying the preeminent place within the political space among all manner of opportunistic coalitions of groups openly and avowedly promoting their sectional interests and agendas that could sometimes appear almost irreconcilable to each other, quite apart from working against the demands of a modern nation in the 21^st century world. An important aspect of freedom interpreted within democratic India is thus an almost infinite tolerance of the articulation of a restricted, sectional identity even if that works at cross purposes with the interest of ‘others’ (beyond the given group or section) and the ‘nation’ as a whole, if that matters any more to the promoters of identity politics in India.

This incidentally seems to be consistent with the common interpretation of secularism as defined in our constitution. Within the scope of this interpretation, the Indian state (governments both at the center and in the states) can not just be neutral about all religions, they will have to actually bend over backwards to publicly support disparate agendas of followers of each religion, which effectively translates to supporting the religious organizations, parties and those ambitious elites leading them. Religion in India is not something of a cultural value system or worldview practiced by individual followers in private, without demonstrably occupying public space or grabbing public attention or demanding expenditure of public money (or the state’s indulgence or munificence in any way).

That is why shifting or demolishing (even under court order) temples or mosques whether these are of older or recent origins on busy public roads causing clear inconvenience to the flow of traffic in a modern Indian city can be an emotive and law and order issue. In the same vein the financial support by the government for the Haj pilgrimage is expected to be a time honored and therefore compulsory gesture that no decent government hoping not to antagonize a religious group can withdraw. Nor can the government afford to show itself to be fatally insensitive by proposing to control the noise levels in the residential areas and townships in modern cities and towns contributed by the quotidian calls to the faithful and blaring of religious sermons and functions over loudspeakers. And to speak of being wary of regimentation and proliferation of very archaic, ultraconservative ideas and mores among the co-believers in such congregations will be construed as sacrilegious.

That is why a literary work like fiction, essay or a poem or a work of art like painting, a cartoon or a film or play in contemporary India can and does routinely run afoul with the sensitivities of the one or the other among the myriad affiliates of religious allegiances. And the secular government respecting the fundamental rights (to preach and practice a religion) of the aggrieved, enshrined under constitution, is expected to assuage the hurt feelings (due to a perceived affront) by promptly stopping a painting exhibition, live performance or a theatre show, denying censorship certificate to a movie and banning the publication and sale of a book. In addition, most often by an unwritten convention, the state has to remain a passive spectator of the active vandalism and destruction of properties by the mortified activists exercising their freedom in dispensing vigilante justice on the perceived infringement of ‘their’ fundamental rights. Curiously, though, the minor matter about protecting the freedom of expression of the artists and writers and filmmakers under the same article of the constitution never arrests the attention of the government.  

It is true that religion happens to be a common enough trigger for backlash on the freedom of expression. However, freedom to preach and practice rabid regionalism, ethno-linguistic chauvinism, to promote caste-based reservation in jobs and promotion, to demand self-determination for a dwindling tribal identity are all very sacrosanct in India. And every Indian worth his salt should clearly know that his freedom to express any rational view on any of these matters is naturally secondary to the primary freedom of a host of other Indians of sensing a hurt in their identity and ideology.   

Interestingly, recent experiences also show that the way governments – both at the center and in the states – respond to an alleged infringement of freedom of belief (in a religion, a cultural practice, a certain ideology etc.) is highly variable. A leader of a political outfit can employ a language in his speech what, for all practical purposes, appears extremely abusive to an average Indian audience in describing or interpreting an action of a political opponent or a group, generally without inviting a rap from the law enforcing authorities.  In the cases of clear hate speech by some politicians against the believers of a rival religion the police have to be literally coaxed and pressured by the superior courts and mounting public opinion to even initiate some tardy actions. But when an anonymous netizen draws a cartoon of a politician and another shares the same over the cyberspace or a non-political challenger like Anna Hazare or Arvind Kejriwal (in the days before the Aam Aadmi Party was born) or Kiran Bedi lampoons a politician these would galvanize privilege motions in the parliament or immediate police actions by cyber-sleuths and arrests (preferably without bail) under tough provisions of the Information Technology Act. When a movie situates a budding terrorist in an in-your-face realistic cultural, religious and social setting, the filmmaker is hauled over coals for religious stereotyping of terrorism and movie theatres vandalized in whipped up public freenzy.     

Thus it is not always important as to what is being said, but rather who is saying that. Freedom is enshrined for a privileged section of the Indians to take offence on the slightest pretext and hurt others by word or action with impunity, but it will be jail for other lesser mortals in the country who dare emulate similar behavior or aspire for the same privileges.

Rise of the middle India (...contd.)

The importance of the growing middle class both as a beneficiary and therefore as the intellectual champion of the robust growth of the pro-market economy under the post 1991 liberalized regime has always been recognized and was welcomed by ruling parties and their backers both in India and abroad. But this was a conveniently wishful view of the role of an emergent constituent of the Indian polity, the youthful face of our democracy. The latter was testified not only by the progressively dipping average age of the people but by the rapidly increasing number of young electorates exercising their franchise during 2009 parliament election and many of the assembly elections thereafter. The influence of these young (many first time) voters in helping other disenchanted sections to seal the fate of the incumbent left front government in West Bengal during May 2011 election has been noted in published statistical analysis.

It has been an euphemism resorted to by most established political parties that these youthful voters everywhere voted for ‘change’ and ‘development’. It is conveniently forgotten that under the glow of the same youthful idealism (innocence if you like) they also expected the operation of the rule of law, an in-your-face honesty both in political and non-political spheres of our social life. They did not expect to see scandals and financial scams tumbling out every other day from within the immaculate corridors of power. They also expected an end to the endemic small micro-level corruption at almost every interface of the public with the government. Anti-corruption movement in 2011 thus found a ready constituency in the educated middle class, students, young professionals, entrepreneurs, etc. It gradually dawned on the ruling classes, going by the turn out in Anna’s meetings at Delhi and in rallies taken out on his call on the streets of metro and other smaller cities, the Indian middle classes mattered no longer just as consumers of pricey, sleek goodies in the malls. That enlightened public opinion against corruption started to matter in the election was writ large on the defeats of the congress party in Goa and the congress supported DMK in Tamil Nadu assembly elections earlier last year.

Apart from the electronic media in this anti-corruption crusade, the emerging technology of the social media and electronic networking was lapped up by the young middle class India and used, probably as never before in a totally public cause, to inform, interact, agitate and mobilize the minds of such a large number of people with relative ease, eloquence and speed that the cacophony in the cyberspace almost resembled and paralleled the slogan-shouting and roaring crowd in the Ram Lila Maidan in Delhi. New means to go with a new movement for achieving a cleaner, more transparent and accountable democratic functioning of the government. Indian middle class thus has acquired a public-spirited voice and a means to make itself heard and be counted. Even numerically it is no longer a push over.     

The unspeakably brutal assault on a young girl (leading to her eventual death) on a cold December night in Delhi was probably like the straw on the camel’s back. Delhi residents, women, young and old, needed no more persuation to say ‘enough’ and hit the streets. Hundreds of young women and yes, young men as well, students from universities, colleges, even school children, women activists, older citizens, congregated from daybreak till night every day at India Gate and an impromptu tableau of collective grief, anguish and anger swelled and brimmed over the majestic path more used to a staged annual display of state power and a cavalcade of phony inclusiveness. Except on that appointed date and time the government found it difficult to be seen to go to the India Gate, and meet the citizens to assuage their grief, to find words of assurance that it understood the real meaning of their ‘we want justice’ outcry which would have carried conviction to the protesters. It was not easy bridging the gulf of trust deficit built up over years of misgovernance and inaction against the gangrenous organs of the state machinery, which has cumulatively over a long period of time created this atmosphere of impunity in which the criminals and their apprentices seem to feel at home and be emboldened.

 

In time all roads to the India Gate were sanitized with canisters of gas and cannons full of water, some young skulls broken in ‘unfortunate’ collateral damages.  But the sound of their footfalls on the empty streets may yet start to sound menacing like Banquo’s visitations in the strategy and plan meetings within stony august buildings reminiscent of raj.

Movement for ensuring dignity and justice for women last year as much as the anti-corruption movement a year ago might be signs of the rising middle India. All power to them.

(concluded)

Rise of the middle India

Though middle classes usually have been perceived by the political establishment to have only marginal importance based on its numerical sparseness vis-à-vis the electoral politics, the centerpiece of a mass democracy like India, they have always played a significant role in shaping the public opinion on a number of issues that affect Indian society, politics and economy.

Till recently, political parties, leaders and their apparatchicks, sympathasiers, apologists in the media generally believed that no matter how much vocal the educated, city-bred critics from among the middle classes appear to be, neither the party ruling the government nor the major opposition parties (harboring an intention to topple it and come to power after the next election) have anything to fear from these agitators because of their own strong ‘mass base’ which in the Indian political lexicon is sometimes pejoratively termed as the ‘vote bank’.

The twin advantages that the political parties had derived (and continue to do so) by sticking to their comfort zone are (a) the numerical preponderance of their support base and (b) the awareness about the lowest common denominator that binds and cements this base, namely, narrow sectional, sectarian, regional, religious interests in the context of winning the electoral battle (which, sadly, has become the be all and end all of the Indian democracy). Indian parties have by and large, over these last sixty five years since independence, found in the issues related to reservation of caste-based job and education quota (with further religion-based sub-quota being attempted recently) much more emotive appeal for the mass electorate they identify as their major constituency, and therefore put their weights behind such slogans and political actions, rather than enlightened measures for bringing corruption under control or to usher gender equality or dignity and justice for women. Also over the years the mainstream parties, often solely governed by populist tailism (not to forget the calculation of the eventual accrual of the electoral benefits) have unwittingly pandered to pressure groups fighting for the recognition of the various regional (even sub-regional or tribal) aspirations and ethnic identities. So much so that today there is a genuine fear of marginalisation of the so-called ‘national’ parties and their increasing irrelevance in major states and regions of this sub-continental nation.

However, over the last decade or so a wind of change has become slowly but surely emerging in various parts of the country, especially in major cities and towns which, somewhat awkwardly, may be described as an awakening of a liberal conscience of an under-performing democracy and it is the middle classes that are taking the lead. Broadly there were four notable developments that could be said to provide a backdrop to the new assertions to reclaim democracy in this country from being hostage to petty party politics.

The landmark public protests by large sections of concerned citizens in respect of the travesty of justice in the Jessica Lal murder case (and the Priyadarshini Mattoo rape and murder case in almost contemporaneous time frame) brought about a new non-political space where students, youth, women, senior citizens, activists, NGOs could publicly articulate their anguish and dismay at the apparent miscarriage of justice. Though limited in scope the successful outcome of these protests in creating enough public pressure to cause revisiting these cases at the higher courts and eventual sentencing of the accused suggested a template for the citizenry to articulate their justified grievances against the non-performance of the machinery of the state. More pertinently, the activists on the streets and their silent supporters in homes and offices saw that money, political connections, muscle power need not invariably tilt the scale of justice in favor of those who flaunt them and ordinary people could get justice from the judicial system which otherwise looked inefficient and ineffective.